Provider First Line Business Practice Location Address:
535 W EATON PIKE
Provider Second Line Business Practice Location Address:
STATE LINE FAMILY MEDICINE
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47374-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-935-8862
Provider Business Practice Location Address Fax Number:
765-935-8863
Provider Enumeration Date:
03/28/2006